Smith G, Ingram A
Tissue Viability Nurse, St. Mary's Hospital, Isle of Wight, UK.
J Wound Care. 2010 Dec;19(12):535-42. doi: 10.12968/jowc.2010.19.12.535.
To determine the effectiveness of Parafricta low-friction garments in reducing the incidence and prevalence of pressure ulceration and to evaluate the curative aspects of these products on pre-existing skin breakdown within a hospital setting.
Patients with a Waterlow score of >15 and who were unable to reposition independently were offered the low-friction undergarments and bootees. A total of 650 patient cases were initially reviewed. Of these, 204 met the criteria for use of the products in the 3 months prior to the start of the evaluation (cohort 1) and 165 patients met the criteria during the period when the garments were used (cohort 2). Data collected included pressure ulcer incidence, location, grading, and outcome of ulcer on discharge. Locally derived costs for length of stay, wound dressings, pressure-redistributing mattresses and additional cost of the low-friction garments were applied to build a cost-effectiveness model.
In patients at risk of skin breakdown there was a statistically significant reduction in the number of patients who developed pressure ulcers following use of the low-friction garments in cohort 2 when compared with cohort 1 (16% reduction; p = 0.0286). In addition, the number of patients who were ulcer free on admission but who developed ulcers and then improved or completely healed before discharge was also statistically significant (41% increase; p = 0.0065) when cohort 2 was compared with cohort 1. Fewer patients admitted with ulcers deteriorated when using the low-friction garments (21% reduction; p = 0.0012). The costs, which were calculated by comparing patient throughput for these patients, suggest that the savings associated with preventing skin breakdown outweighed the cost of the products used (base case model indicated a saving of over £63,000 per 100 at risk patients).
The results support the conclusion that low-friction garment products have a role to play in the prevention of skin breakdown, and appear to be both clinically effective and cost effective.
The authors have no conflicts of interest to declare. APA Parafricta provided the products, as well as financial support for training of the ward staff who participated in the evaluation and for the data collection and analysis (which was performed by Xcelerate Health Outcomes Unit, NHS Innovations London).
确定Parafricta低摩擦服装在降低压疮发生率和患病率方面的有效性，并评估这些产品对医院环境中已存在的皮肤破损的治疗效果。
为Waterlow评分>15且无法自主翻身的患者提供低摩擦内衣和鞋套。最初共审查了650例患者病例。其中，204例在评估开始前3个月符合产品使用标准（队列1），165例患者在使用该服装期间符合标准（队列2）。收集的数据包括压疮发生率、位置、分级以及出院时溃疡的转归。应用当地得出的住院时间、伤口敷料、减压床垫的费用以及低摩擦服装的额外费用来建立成本效益模型。
在有皮肤破损风险的患者中，与队列1相比，队列2中使用低摩擦服装后发生压疮的患者数量有统计学显著减少（减少16%；p = 0.0286）。此外，入院时无溃疡但发生溃疡且在出院前病情改善或完全愈合的患者数量，与队列1相比也有统计学显著增加（增加41%；p = 0.0065）。使用低摩擦服装时，入院时有溃疡的患者病情恶化的较少（减少21%；p = 0.0012）。通过比较这些患者的患者流量计算得出的成本表明，预防皮肤破损带来的节省超过了所使用产品的成本（基础案例模型表明，每100名有风险的患者可节省超过63,000英镑）。
结果支持以下结论，即低摩擦服装产品在预防皮肤破损方面有作用，并且似乎在临床和成本效益方面均有效。
作者声明无利益冲突。Parafricta提供了产品，以及用于培训参与评估的病房工作人员和数据收集与分析的资金支持（数据收集与分析由伦敦国民保健服务创新局的Xcelerate健康结果部门进行）。
